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Metastatic ampullary adenocarcinoma in exfoliative sputum cytology: A rare presentation.

Roy M, Agarwal S, Mridha AR, Arora J, Madan K, Jain D, Mathur S - Lung India (2015 Sep-Oct)

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, All India Institute of Medical Sciences, New Delhi, India E-mail: dr.shipra0902@gmail.com.

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Sir, The ampulla of Vater is a complex structure formed by the sphincter of Oddi muscle surrounding the confluence of the distal common bile duct (CBD) and main pancreatic duct that opens at the papilla of Vater on the medial wall of the duodenum... We diagnosed a case of metastatic adenocarcinoma to the lung in a patient with ampullary primary in exfoliative sputum cytology... The tumor was characterized as pT3, pN0, M0, and bracketed in stage IIA disease... He did not receive any adjuvant chemotherapy... Chest radiography has poor overall sensitivity in the detection of lung metastasis... Newer advanced imaging techniques such as computed tomography with superior sensitivity and resolution is routinely used for diagnosis of lung metastasis... In a study published way back in 1971 by Oswald et al., evaluation of one or more satisfactory sputum specimens from 2035 patients gave a pathological proof of primary lung carcinoma in 59% of patients and positivity rate escalated to 69% and 85% when three and four or more specimens were tested, respectively... Agustí et al., reported a higher diagnostic yield of induced sputum compared with spontaneous sputum in patients with peripheral lung tumors who had normal bronchoscopic evaluation... However, when dealing with metastatic tumors, sputum cytology is touted to have a poorer diagnostic yield... Ali et al., retrospectively reviewed the positive sputum samples of 35 patients with metastatic tumors involving the lung and observed intact tumor architecture in the exfoliated cells in 75% of patients... Metastatic colonic adenocarcinoma was the commonest primary site... Radford et al., evaluated the sputum samples of 22 patients with pulmonary metastases from colorectal adenocarcinoma with a positive or atypical result in 65% of cases... To the best of our knowledge, no case of metastatic ampullary carcinoma to the lung with the pathological diagnosis established on sputum cytology has been reported so far... Sputum cytology for malignant cells in suspected lung metastasis has largely been shelved and replaced by more invasive cytological techniques such as FNAC, bronchoscopic washings and BAL... The newer modalities, besides having a higher sensitivity, also provide a platform for immunocytochemistry on cell block preparation.

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(a) Adenocarcinoma of the ampulla of Vater (hematoxylin and eosin, ×10), (b) Positron emission tomography (PET) scan showing bilateral hypermetabolic lung nodules, (c and d) Sputum cytology showing clusters of malignant cells from metastatic adenocarcinoma (Papanicolaou stain, ×10 and ×40, respectively)
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Figure 1: (a) Adenocarcinoma of the ampulla of Vater (hematoxylin and eosin, ×10), (b) Positron emission tomography (PET) scan showing bilateral hypermetabolic lung nodules, (c and d) Sputum cytology showing clusters of malignant cells from metastatic adenocarcinoma (Papanicolaou stain, ×10 and ×40, respectively)

Mentions: A 55-year-old man underwent pancreaticoduodenectomy in April, 2013, in a private hospital for carcinoma of the ampulla of Vater. The discharge summary mentioned a moderately differentiated adenocarcinoma [Figure 1a] invading the pancreas with resection margins free of tumor, no nodal involvement or clinicoradiological evidence of distant metastasis. The tumor was characterized as pT3, pN0, M0, and bracketed in stage IIA disease. He did not receive any adjuvant chemotherapy.


Metastatic ampullary adenocarcinoma in exfoliative sputum cytology: A rare presentation.

Roy M, Agarwal S, Mridha AR, Arora J, Madan K, Jain D, Mathur S - Lung India (2015 Sep-Oct)

(a) Adenocarcinoma of the ampulla of Vater (hematoxylin and eosin, ×10), (b) Positron emission tomography (PET) scan showing bilateral hypermetabolic lung nodules, (c and d) Sputum cytology showing clusters of malignant cells from metastatic adenocarcinoma (Papanicolaou stain, ×10 and ×40, respectively)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4587022&req=5

Figure 1: (a) Adenocarcinoma of the ampulla of Vater (hematoxylin and eosin, ×10), (b) Positron emission tomography (PET) scan showing bilateral hypermetabolic lung nodules, (c and d) Sputum cytology showing clusters of malignant cells from metastatic adenocarcinoma (Papanicolaou stain, ×10 and ×40, respectively)
Mentions: A 55-year-old man underwent pancreaticoduodenectomy in April, 2013, in a private hospital for carcinoma of the ampulla of Vater. The discharge summary mentioned a moderately differentiated adenocarcinoma [Figure 1a] invading the pancreas with resection margins free of tumor, no nodal involvement or clinicoradiological evidence of distant metastasis. The tumor was characterized as pT3, pN0, M0, and bracketed in stage IIA disease. He did not receive any adjuvant chemotherapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, All India Institute of Medical Sciences, New Delhi, India E-mail: dr.shipra0902@gmail.com.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Sir, The ampulla of Vater is a complex structure formed by the sphincter of Oddi muscle surrounding the confluence of the distal common bile duct (CBD) and main pancreatic duct that opens at the papilla of Vater on the medial wall of the duodenum... We diagnosed a case of metastatic adenocarcinoma to the lung in a patient with ampullary primary in exfoliative sputum cytology... The tumor was characterized as pT3, pN0, M0, and bracketed in stage IIA disease... He did not receive any adjuvant chemotherapy... Chest radiography has poor overall sensitivity in the detection of lung metastasis... Newer advanced imaging techniques such as computed tomography with superior sensitivity and resolution is routinely used for diagnosis of lung metastasis... In a study published way back in 1971 by Oswald et al., evaluation of one or more satisfactory sputum specimens from 2035 patients gave a pathological proof of primary lung carcinoma in 59% of patients and positivity rate escalated to 69% and 85% when three and four or more specimens were tested, respectively... Agustí et al., reported a higher diagnostic yield of induced sputum compared with spontaneous sputum in patients with peripheral lung tumors who had normal bronchoscopic evaluation... However, when dealing with metastatic tumors, sputum cytology is touted to have a poorer diagnostic yield... Ali et al., retrospectively reviewed the positive sputum samples of 35 patients with metastatic tumors involving the lung and observed intact tumor architecture in the exfoliated cells in 75% of patients... Metastatic colonic adenocarcinoma was the commonest primary site... Radford et al., evaluated the sputum samples of 22 patients with pulmonary metastases from colorectal adenocarcinoma with a positive or atypical result in 65% of cases... To the best of our knowledge, no case of metastatic ampullary carcinoma to the lung with the pathological diagnosis established on sputum cytology has been reported so far... Sputum cytology for malignant cells in suspected lung metastasis has largely been shelved and replaced by more invasive cytological techniques such as FNAC, bronchoscopic washings and BAL... The newer modalities, besides having a higher sensitivity, also provide a platform for immunocytochemistry on cell block preparation.

No MeSH data available.


Related in: MedlinePlus